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Background: This study evaluated the effect of adjuvant chemotherapy and hormone therapy on overall survival and disease-free survival in patients with breast cancer with hormone receptor-positive, HER2-negative tumors without lymph node involvement. Methods: Breast cancer patients with hormone receptor-positive, HER2-negative, and no lymph node involvement were included in this retrospective cohort study. Patient records were used to collect data on sex, age, time of disease onset, tumor subtype, tumor size, grade, lymphovascular and perineural involvement, ki67, and treatment protocols. Patients were divided into 2 groups: Patients who received both adjuvant chemotherapy and hormonal therapy and patients who received hormonal therapy only. Disease-free survival index (DFS) and overall survival index (OS) were evaluated. Results: Sixty-seven female patients were enrolled in this study. Of them, 68.2% received both adjuvant chemotherapy and hormonal therapy and 31.6% received hormonal therapy only. During follow-up, recurrences occurred in 8 patients. The 3-year and 5-year DFS were 93.4% and 90%, respectively. The 3-year and 5-year DFS was 94% and 92%, respectively, in patients who received both adjuvant chemotherapy and hormonal therapy, and 91% and 85%, respectively, in patients who received hormonal therapy. None of the factors studied affected the 3-year and 5-year DFS. The 3-year and 5-year DFS OS were 98.6% and 96.9%, respectively Conclusion: Adjuvant chemotherapy in patients with breast cancer with hormone receptor-positive, HER2-negative, and no lymph node involvement compared with similar patients receiving hormone therapy alone had no significant difference in disease-free survival index and overall survival index. [ABSTRACT FROM AUTHOR]

Objective: The pathologic complete response (pCR) in the breast and axillary lymph node after neoadjuvant chemotherapy (NAC) would improve outcomes and it is used as a surrogate marker for survival. Our objective was to evaluate the breast and nodal pCR in breast cancer patients with estrogen receptor-positive (ER) and HER2 negative subtypes. Meanwhile, we sought to examine the impact of predicting factors on the rate of pCR. Materials and Methods: In this multicenter retrospective study, medical records data of 314 women with ER+/HER2-breast cancer subtype who received neoadjuvant chemotherapy was extracted from oncology centers' data between 2011 and 2018. Breast and axillary lymph node pCR were assessed. Meanwhile, receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value for proliferative index (Ki-67%) expression. Results: Breast pCR was seen in 25.2% (n=79) of the 314 cancer patients and partial response was seen in 47.8% (n=150), too. Nodal pCR was reported in 30.9% (n=97) of the 249 node-positive patients. The overall pCR (both breast & node) was observed in 14.6 % (n=46) of the 272 patients in which the data of breast and nodal were available. We identified 22.5% as the best cut-off value for ki-67 expression in predicting complete response to NAC. Conclusion: The pCR rate after NAC in ER+/HER2-subtypes of breast cancer is low. Therefore, the optimal therapy for these patients should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Anti-cancer potential of silymarin has been shown in cell culture. However, no prospective clinical study has been conducted in this relation. Methods: In a randomized double blind pilot study, we compared effects of addition of standard chemotherapy along with silymarin (420mg/day) versus placebo on clinical response of advanced tumors after three cycles of cisplatin-based chemotherapy. Results: There was no significant difference in tumor size after three consecutive chemotherapy courses but a trend toward lower metastasis rate in chemotherapy + silymarin group. Concomitant use of silymarin and chemotherapy was very well tolerated but didn't significantly increase clinical response. Conclusion: Due to the trend towards significantly lower metastasis in silymarin group, further study with larger sample size is needed to better clarify probable role of adjunctive therapy with silymarin in patients with solid tumors. [ABSTRACT FROM AUTHOR]

Background: Healthcare horizon scanning systems, have become one of the main components of health technology assessment. We conducted a horizon scanning exercise to identify new oncology drugs that may have a high impact on cancer patients and the health system in Iran. Methods:We reviewed existing health technology horizon scanning systems, and selected and weighted criteria for prioritizing oncology drugs, including 1) clinical efficiency and effectiveness, 2) incidence and prevalence of cancer types, 3) potential costs, 4) availability of alternative treatment, 5) having variable indications, 6) quality of evidence, and 7) being a first, second or third line drug. We reviewed horizon scanning reports in other countries and prepared a list of new oncology drugs to be ranked. We summarized clinical and epidemiological information about the drugs and presented them to a member of our expert panel who ranked them based on a structured checklist. Eventually, the drugs were categorized into four groups from low to high impact, based on their effect on patients and the health system of Iran in the future Results: We identified 158 new oncology drugs, most of which were in their phase III clinical trials, and had been approved by the US Food and Drug Administration (FDA). Finally, we selected 18 medicines as having the highest impact on patients and the health system of Iran. Conclusion: The results of this study can be used for several purposes, including research and drug development. These results suggest the need for periodical horizon scanning in Iran and other low and middle income countries. [ABSTRACT FROM AUTHOR]

Background: Triple-negative breast cancers (TNBC) have a more aggressive course and are associated with poorer prognosis in comparison with other subtypes of breast cancer. One of the most common subtypes of TNBC is basal-like. The aim of this study was to investigate clinicopathological characteristics and clinical course of TNBC in Iranian women and compare them with other studies. Subjects and Methods: Between March 2009 and February 2011, patients with breast cancer in Cancer Institute of Iran were selected and then followed-up for 2 years. Paraffin-embedded tumor block of all TNBC patients were evaluated for CK5/6 and EGFR using IHC method. Results: Among 267 breast cancer patients, 60 cases with TNBC were identified (22.5%), 31 patients (51.7%) had basal-like and 29 patients (48.3%) had non-basal-like tumors. The median age of participants with TNBC was 49.6 years. Among our patients, 70% had positive lymph nodes.93.4% of all patients at the time of diagnosis were stage II or III and tumor size was at least 3 centimeters. No grade 1 TNBC was found in this study. During the follow-up period, there were 26 recurrences and 7 deaths. Conclusion: The percentage of basal-like subtype among Iranian women with TNBC was lower compared to other studies, while bone metastases, clinical stage, lymph node involvement and tumor size were higher. Clinicopathological findings in basal and non-basal-like subgroups were not different, but the probability of lymph node involvement was more common in patients who were EGFR positive. [ABSTRACT FROM AUTHOR]

Triple negative breast cancers (TNBCs) are associated with aggressive course, higher rates of visceral and central nervous system metastases and lower survival rate than hormone receptor positive. Once metastasis has occurred, a median survival was approximately one year. Currently, chemotherapy in TNBC is similar to other HER2- negative breast cancers but in the near future, it will revolutionize. TNBCs are quite heterogeneous based on biomarkers and genetic variations. The series of new drugs have been tried; in this article, platinum, anti-epigenetic drugs, PARP inhibitors, epidermal growth factor receptor inhibitor, Src family kinase inhibitor, anti androgen, glycoprotein Non-metastatic melanoma B (gpNMB) antibody, LHRH conjugated to cytotoxic drugs and inhibition of the PI3K/AKT/mTOR pathway will be explained. What is the optimal therapy for TNBC patients? It is still not clear but it seems that the road map according to biological and genetic markers is taking shape. [ABSTRACT FROM AUTHOR]

Background: Although medical oncologists can have an important role in controlling the cost of cancer treatment, there is little information about their attitudes toward the cost of cancer treatment and the impact of cost on their treatment recommendations, especially in low- and middle-income countries (LMICs). In this study, we assessed the attitude of Iranian medical oncologists toward some economic aspects of new cancer drugs. Methods: We translated a questionnaire that was used in similar studies in the United States and Canada into Persian and modified it according to the local setting in Iran. The face and content validity of the questionnaire were assessed by oncologists before being used in the survey. We distributed the questionnaire and collected the data from 80 oncologists who participated in the 13th Annual Congress of the Iranian Society of Medical Oncology and Hematology (ISMOH). Results: Fifty-two oncologists participated in our study (a response rate of 65%). The majority of oncologists stated that drug costs and patient out-of-pocket (OOP) costs influence their treatment recommendations (92% and 94%, respectively). Most oncologists (70%) felt that they are ready enough to use cost-effectiveness information in their treatment decisions, and 74% believed that patients should only have access to cancer treatments that are cost-effective. Most oncologists agree that the government should have control over drug prices, and more use of cost-effectiveness data is required for decision-making about cancer drug coverage. Ninety-one percent of oncologists said that they always or frequently discuss cancer treatment costs with their patients. Oncologists believed that academic groups (research centers and scientific societies) (81%) and the Ministry of Health (MoH) (43%) are the most eligible groups for determining whether a drug provides good value. Conclusion: Iranian medical oncologists are ready to participate in the health technology assessment and prioritysetting process. This situation creates a unique opportunity for the government to rely on scientific societies and find an appropriate solution for the improvement of patients' access to high-quality care. [ABSTRACT FROM AUTHOR]

The coexistence of two malignancies is rarely seen. A little association between hematologic malignancies especially multiple myeloma and renal cell carcinoma has been reported in the recent past. Several case series revealed a bidirectional association between these two malignancies which may be due to the common risk factors, similar cytokine growth requirements and clinical presentation. Here, we aim to describe a patient who had multiple myeloma and in his work up renal cell carcinoma was found out incidentally. We would like to create awareness among clinicians for the coincidence of Renal cell carcinoma and Multiple myeloma. [ABSTRACT FROM AUTHOR]

Systemic therapy is one of the cornerstones of cancer treatment. In 1972, following representations by American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine (ABIM) recognized medical oncology as a new subspecialty of internal medicine. Subspecialty of Hematology and Medical Oncology was emerged in Iran in 1983. In the past, modern medical treatments and education were started in Dar Al-fonun school and then in Tehran University; now six universities in Iran are training in Subspecialty of Hematology and Medical Oncology. There are also ten active hematopoietic stem cell transplantation centers, thirty-one provincial medical schools, use their specialized services. Future goals for Hematology and Medical Oncology in Iran include expansion and reinforcement of multidisciplinary teams across the country, early detection and prevention of cancer, providing educational program and conducting cancer researches. To achieve these goals, it is necessary to establish Cancer Hospitals in each province that link together through a network. [ABSTRACT FROM AUTHOR]

Amegakaryocytic thrombocytopenia (AMT) is a rare cause of acquired thrombocytopenia. The pathogenesis and treatment of AMT is not clearly known. Here we demonstrate a 50-year-old man presented with the clinical manifestations of severe thrombocytopenia (7000 platelets/μl) with a marked decrease to absent of megakaryocytes in the bone marrow. The patient did not respond to intravenous immunoglobulin, cyclosporine or high dose prednisone. After the treatment with anti-CD20 antibody (Rituximab), the patient's clinical symptoms and platelet counts improved. [ABSTRACT FROM AUTHOR]

Background: Burden of cancer is increasing in developing countries, where healthcare infrastructures and resources are limited. Evaluating the pattern of care would provide evidence for planning and improvement of the situation. Materials and Methods: We studied the pattern of residential place and clinical information of cancer patients who were admitted to the Cancer Institute of Iran from January 1, to May 31, 2012. Results: We studied 1,705 consecutive cancer patients admitted to the Cancer Institute in the study period. The most common cancers were breast (29.2%), colorectal (9.0%), stomach (8.3%), head & neck (8.0%) and esophageal (3.8%) cancers. Radiotherapy was the main treatment (52.1 %) followed by chemotherapy (43.8%) and surgery (29.1 %). We found that 60% of the patients presented in the loco-regional or advanced stages. About 35% of patients travelled from other provinces mainly from Mazandaran (13.4%), Lorestan (10.6%), Zanjan (7.8%) and Ghazvin (6.6%). On average, the cancer patients travelled about 455 kilometers to receive care in the cancer institute. We found more than 38% patients who were referred from other provinces had an early stage tumor. Conclusion: Establishment of comprehensive cancer centers in different geographical regions and implementation of a proper referral system for advanced cancer patients is needed to improve the patient outcomes and mitigate the burden of travel of patients for cancer care. [ABSTRACT FROM AUTHOR]

Introduction: Cisplatin is a widely used chemotherapeutic agent with a major side effect of nephrotoxicity. Delayed increase in serum creatinine after cisplatin injection makes serum creatinine not to be an ideal marker for early detection of cisplatin nephrotoxicity. Recently several new biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) have been proposed for early detection of acute kidney injury (AKI). This study assessed kinetic of urine NGAL-creatinine ratio in patients who received cisplatin-containing chemotherapy. Materials and Methods: Patients with a glomerular filtration rates greater than 45 mL/min who received cisplatin-containing chemotherapy were included. Urine creatinine and NGAL concentrations were measured before cisplatin infusion and 6, 24, 48, and 72 hours after cisplatin administration. To minimize hydration effects, urine NGAL levels were adjusted according to urine creatinine. Results: Twenty-four patients were assessed. According to the Acute Kidney Injury Network criteria, 2 patients (8%) experienced cisplatin-associated AKI. The median increases in urine NGAL-creatinine ratio  were 335% (interquartile range, 320% to 350%) in the patients with AKI and 100% (interquartile range, 73% to 190%) in those without AKI (P = .02) during the first 24 hours after cisplatin administration. A urine NGAL-creatinine ratio greater than 26.9 ng/mg 24 hours after cisplatin infusion had a sensitivity of 86% and a specificity of 50% to detect cisplatin-associated nephrotoxicity. Conclusions: Urine NGAL-creatinine ratio significantly increased in patients with cisplatin-associated AKI. Urine NGAL-creatinine ratio within the first 24 hours after cisplatin infusion may better predict cisplatin-associated nephrotoxicity than serum creatinine level. [ABSTRACT FROM AUTHOR]

Background: CRC is the second and third most common cancer in women and men, respectively. The national comprehensive cancer network guidelines recommend oxaliplatin-based chemotherapy as a preferred regimen for patients with advanced or metastatic colon cancer. Oxaliplatin is also used in the off-label treatment of gastric cancer. FDA uses post-marketing study commitments to gather additional information about a product's safety, efficacy, or optimal use. It is necessary to perform safety monitoring after marketing authorization is received; such monitoring can be done by means of characterizing the safety of drugs in patients being treated in real-world clinical practice settings., Objectives: This Phase IV study aimed to evaluate the safety profile of a brand-name formulation of the generic drug oxaliplatin (Alvoxal Ⓡ , NanoAlvand, Tehran, Iran) in Iranian patients diagnosed with either colorectal or other, different types of cancer., Methods: Patients with colorectal cancer, gastric cancer, or other malignancies receiving oxaliplatin as a part of their treatment were included in this open-label, multicenter, observational Phase IV study. This study aimed to assess the safety profile of oxaliplatin in patients diagnosed with different cancers., Findings: A total of 483 patients from 16 cities in Iran were enrolled. The most common malignancy was colorectal cancer (55.49%), followed by gastric cancer (28.16%). Based on the results, 405 patients experienced at least 1 adverse event. Most of these adverse events were grade 1 or 2, and the most commonly reported adverse event was anemia (60.66%). During the study, 26 serious adverse events occurred in 15 (3.11%) patients, which were perhaps related to oxaliplatin. There were no remarkable differences in the incidences of adverse events in the system organ classes of blood and lymphatic system disorders, gastrointestinal disorders, or nervous system disorders among patients with different malignancies (ie, colorectal cancer, gastric cancer, and other malignancies) or between genders. The results of this open-label, multicenter, observational, postmarketing surveillance study demonstrated no unexpected safety findings from the use of this oxaliplatin product (Alvoxal Ⓡ ) in Iranian patients diagnosed with different types of cancer., Conclusions: This Phase IV study provides data on the safety profile of a number of chemotherapy regimens containing an oxaliplatin product given to Iranian patients diagnosed with different types of cancer., (© 2021 The Authors.)

Background: Burden of cancer is increasing in developing countries, where healthcare infrastructures and resources are limited. Evaluating the pattern of care would provide evidence for planning and improvement of the situation., Materials and Methods: We studied the pattern of residential place and clinical information of cancer patients who were admitted to the Cancer Institute of Iran from January 1, to May 31, 2012., Results: We studied 1,705 consecutive cancer patients admitted to the Cancer Institute in the study period. The most common cancers were breast (29.2%), colorectal (9.0%), stomach (8.3%), head & neck (8.0%) and esophageal (3.8%) cancers. Radiotherapy was the main treatment (52.1%) followed by chemotherapy (43.8%) and surgery (29.1%). We found that 60% of the patients presented in the loco-regional or advanced stages. About 35% of patients travelled from other provinces mainly from Mazandaran (13.4%), Lorestan (10.6%), Zanjan (7.8%) and Ghazvin (6.6%). On average, the cancer patients travelled about 455 kilometers to receive care in the cancer institute. We found more than 38% patients who were referred from other provinces had an early stage tumor., Conclusion: Establishment of comprehensive cancer centers in different geographical regions and implementation of a proper referral system for advanced cancer patients is needed to improve the patient outcomes and mitigate the burden of travel of patients for cancer care.